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Background: Patients undergoing vaginal hysterectomy with native tissue pelvic reconstruction typically have low pain levels overall in the postoperative period. Notwithstanding, pain control immediately after surgery may be more challenging and a barrier to same-day discharge. Intrarectal diazepam has been used for acute and chronic pelvic pain and has a pharmacokinetic profile ideal for intermittent use. However, its use has not been investigated after the surgical intervention.Objective: This study aimed to evaluate the effect of diazepam rectal suppositories on early postoperative pain after hysterectomy and vaginal reconstruction for pelvic organ prolapse.Study Design: This was a double-blind, randomized, placebo-controlled trial comparing postoperative pain scores after vaginal hysterectomy with native tissue prolapse repairs. Patients were randomized to receive either an intrarectal 10-mg diazepam suppository or an identical placebo. Moreover, the participants completed the questionnaires at baseline, the morning of postoperative day 1, and 2 weeks after the operation. Surveys included visual analog scales for pain, a validated Surgical Satisfaction Questionnaire, and queries regarding medication side effects and postoperative recovery. The primary outcome was pain scores based on a visual analog scale approximately 3 hours after surgery. The secondary outcomes included total morphine equivalents after surgery, patient satisfaction with pain control, same-day discharge outcome, and overall satisfaction. The chi-square, Fisher exact, and Mann-Whitney tests were used. Based on a 10-mm difference in postoperative vaginal pain using the visual analog scale, sample size was calculated to be 55 patients in each arm to achieve 80% power with an alpha of.05.Results: From February 2020 to August 2021, 130 participants were randomized. Of those participants, 7 withdrew, and 123 were analyzed: 60 in the diazepam group and 63 in the placebo group. The median age was 65 years (interquartile range, 27-80), the median body mass index was 27.9 kg/m2 (interquartile range, 18.70-45.90), and 119 of 123 participants (96.7%) were White. There was no difference in the baseline characteristics, prolapse stage, or types of procedures performed between groups. Most participants had concurrent uterosacral ligament suspension with anterior and posterior repairs. Of note, 50 of 123 participants (41%) had midurethral slings. Moreover, 61 of 123 participants (50%) were discharged on the day of surgery. There was no difference in the primary outcome of vaginal pain 3.5 to 6.0 hours postoperatively (25 vs 21 mm; P=.285). In addition, the amount of rescue narcotics used in the immediate postoperative period (19.0 vs 17.0 MME; P=.202) did not differ between groups. At 2-weeks postoperatively, patients in the placebo group reported higher satisfaction with pain control in the hospital (31 vs 43 mm; P=.006) and pain control at home (31 vs 42 mm; P=.022). No difference was noted between same-day discharges and those who were admitted overnight.Conclusion: The placement of a 10-mg diazepam rectal suppository immediately after pelvic reconstructive surgery did not improve pain or narcotic usage in the early postoperative period. Although the placebo group reported slightly higher satisfaction with pain control 2 weeks after surgery, overall pain levels were low. Therefore, we do not believe that the addition of diazepam to the postoperative regimen is warranted. [ABSTRACT FROM AUTHOR]

Abstract: Table Mountain pine (Pinus pungens Lamb.) is an Appalachian endemic that occurs in a patchy distribution from Georgia to Pennsylvania on xeric, fire-prone sites. Beginning in the 1990s, Table Mountain pine first showed usefulness in reconstructing fire regimes in these xeric Appalachian forests. The next step in Table Mountain pine research, the relationships between fire occurrence and climate variables, cannot happen until the dendrochronological potential of the species has been proven. This research investigates the annual ring structure and formation, relationship between climate and growth, and dendrochronological dating between trees in the same stands to prove the species’ effectiveness in climate reconstructions. Table Mountain pine cores and cross-sections were collected from four sites in the Virginia Appalachian Mountains. Results indicate that the species is sensitive to climate (monthly precipitation and temperature, PDSI and PHDI). Climate analyses revealed that Table Mountain pine growth is reduced when the previous year''s September is drier than normal, the current year’s February is wetter than average, and the winter is colder than average. Results of these climate analyses illustrate a regional climate signal in Table Mountain pine stands; however, results from individual sites provided more significant details on the influence of climate on the species. [Copyright &y& Elsevier]

An analysis of spatial dispersion was conducted for individual tree species in the old-growth forest at the Davis-Purdue Research Forest in Indiana. This 20.6 ha stand has been left largely undisturbed by exogenous factors since its acquisition by Purdue in 1917. It is the only long-term study plot of its size for a temperate hardwood forest with x–y coordinates (rectangular plot) for all species above 10 cm diameter. Full censuses have been conducted spanning 60 years (1926, 1976 and 1986).Ripley’s L(t) function revealed that most species are characterized by some form of aggregation, agreeing with a prior evaluation from 1981. Heterogeneity of spatial structure was evident between two large plots, indicating that differences in site quality and history had influenced spatial structure. Shade-intolerant species were numerically dominant and spatially aggregated in 1926 but have declined over the 60-year interval and become more random in spatial dispersion. Shade-tolerant species have increased in number and become more aggregated over time, or they exhibit little change in spatial structure. Examples of the latter include Acer saccharum and Ulmus americana, species that experienced explosive population growth. These contrasting patterns are masked by stand-level patterns that show a trend toward uniformity over the same time frame.These data reveal that changes in dispersion accompany the demographic failure experienced by numerous tree species in Central Hardwood old-growth stands, and these changes may feed back into a negative population cycle and further impede regeneration. The simultaneous manipulation of dispersion and density should be considered as a tool for influencing forest succession and promoting regeneration of desired tree species. [Copyright &y& Elsevier]